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DOI: 10.1055/s-0038-1640260
Extensive cholesteatoma of the temporal bone with compression of the posterior fossa and midline displacement
Introduction:
A cholesteatoma is a locally destructive mass of the petrous bone that rarely grows extratemporally. An extratemporal extension is found mainly in medial cholesteatomas.
Methods:
Case report of a patient with an extensive cholesteatoma of the temporal bone with compression of the posterior fossa and midline displacement.
Case study:
A 59-year-old male presents with tinnitus on the left side and vertigo. An MRI showed a 6 cm expansive tumor of the left temporal bone, which displaced the parenchyma of the cerebellum. A CT of the petrous bone presented an erosion of the posterior semicircular canal as well as an enlargement of the aqueduct vestibuli.
Intraoperatively it showed a temporal bone cholesteatoma, which could be removed by opening the posterior fossa and performing a radical mastoidectomy. It also showed a vertical mucosal fold appeared along the long process of the incus, separating the anterior epitympanon and mesotympanon from the antrum and allowing to develope a congenital cholesteatoma behind. The cholesteatoma invaded the aqueduct vestibuli, which explains the aqueduct vestibuli shown enlarged on the preoperative CT. The canal of the facial nerve was destroyed over a distance of 2 mm in the mastoid, and the posterior semicircular canal was destroyed over a distance of 3 mm and was exposed. Immediate coverage of semicircular dehiscence revealed an unchanged postoperative bone conduction hearing threshold.
Conclusion:
As differential diagnosis, this case is valuable because the dilatation of the aqueduct vestibuli was the result of the cholesteatoma and not the cause – as in an idiopathic "enlarged vestibular aquaeduct syndrome".
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No conflict of interest has been declared by the author(s).
Publication History
Publication Date:
18 April 2018 (online)
© 2018. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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